Condition: de Quervain Tenosynovitis is a condition that causes the tendons to swell around the base of the thumb, leading to thumb and wrist irritation and pain with movement.
Background: Most experts believe de Quervain Tenosynovitis is caused by overuse of the thumb, however, the exact cause is unknown. It can develop after a thumb injury, repetitive movements that involve the thumb, post-partum (from breast feeding, or repeatedly lifting a car seat), rheumatoid arthritis, and other inflammatory conditions.
Risk Factors: de Quervain Tenosynovitis affects more women than men, particularly middle-aged women and those who have recently given birth. Workers who must forcefully grip items or repetitively grasp with their thumb are also at greater risk. Additionally, certain leisure activities can put people at risk including but not limited to: golfing, gardening and playing racquet sports
History and Symptoms: Pain and swelling is typically felt along the back of the thumb, up the wrist and into the forearm. It can happen gradually or suddenly, and it is often hard and/or painful to move the thumb. Pinching or grasping items may be difficult, and the thumb may be swollen or hard to move.
Physical Exam: Physicians will inspect for swelling and fullness around the thumb. The physician will perform a physical exam of the area causing pain and discomfort. Using the Finkelstein test, the physician will take the patients thumb and maneuver it towards the pinky to assess for pain. The physician may also perform the Eichoff Maneuver where a patient makes a fist, with the thumb resting inside the palm. Next, the physician bends the wrist toward the outside of the hand. If there’s pain with either test, it usually indicates de Quervain Tenosynovitis.
Diagnostic Process: The Finkelstein test and Eichoff manuever alone are often all that is needed to diagnose de Quervain Tenosynovitis. A physician may obtain blood work or other imaging, such as, an x-ray to ensure there is no other issue.
Rehab Management: A physical medicine and rehabilitation (PM&R) physician, also known as a physiatrist, plays a key role in managing and coordinating the care for patients with this condition. A PM&R physician will help identify the specific activities or positions the patient is using that may be aggravating the problem, and provide modalities such as ice/heat, splinting, and ultrasound therapy to reduce the pain. A corticosteroid injection is one of the best ways to reduce swelling and pain. Other types of medication can be injected including dextrose (called prolotherapy) or platelet rich plasma. Along with injections, a PM&R physician will work with the patient to create an individualized plan for rehabilitation, taking into account the patient's daily activities, work, and recreation. Once the condition is improving, a PM&R physician will prescribe specific exercises to reduce stiffness and improve range of motion and strength, thus reducing further damage and prevent future flares. A PM&R physician’s ultimate goal is assisting the patient in being as independent as possible and helping the patient return to their normal daily life.
Other Resources for Patients and Families: Patients and families should recognize that even though only the thumb is affected, the patient may still need significant support. This includes help with basic tasks such as: getting dressed, opening jars and other activities of daily living. In addition, providing social and emotional support can assist with the patient's mental health and ultimate recovery.